Clin Orthop Surg.  2015 Mar;7(1):29-38. 10.4055/cios.2015.7.1.29.

Modified Stoppa Approach for Surgical Treatment of Acetabular Fracture

• Kim HY
• Yang DS
• Park CK
• Choy WS

• KMID: 2069872
• DOI: http://doi.org/10.4055/cios.2015.7.1.29

Abstract

BACKGROUND
We analyzed the extent of the comminution in the acetabular weight-bearing area, the clinical and radiographic results, and the complications after a minimum 2-year follow-up of the modified Stoppa approach for the treatment of acetabular fractures, and we attempted to evaluate the efficacy of the operative technique.
METHODS
All of the 22 patients, who needed the anterior approach for the treatment of acetabular fractures at our hospital from November 2007 to November 2010, were subjected to surgery via the modified Stoppa approach. Fracture pattern, operative time, blood loss during the operation, quality of reduction, number of bony fragments in the acetabular weight-bearing area, and postoperative complications were assessed by retrospectively analyzing the medical records and the radiographic examinations. The results after the operation were analyzed based on the criteria of Matta.
RESULTS
The clinical results were excellent in 3 cases, good in 13 cases, and poor in 4 cases, while the radiographic results were excellent in 5 cases, good in 13 cases, and poor in 2 cases. Although the quality of reduction and the clinical results according to the extent of comminution were statistically significant (p = 0.03 and p = 0.04, respectively), the radiographic results were not statistically significant (p = 0.74).
CONCLUSIONS
It can be concluded that the modified Stoppa approach could be used as an alternative to the classic ilioinguinal approach. In addition, comminution of the acetabular fracture was an important factor causing non-anatomic reduction and finally unsatisfactory clinical results.

Keyword

Acetabulum; Acetabular fracture; Stoppa approach

MeSH Terms

Acetabulum/injuries/radiography/*surgery
Adult
Aged
Female
Fracture Fixation, Internal/*methods
Fractures, Bone/radiography/*surgery
Fractures, Comminuted/radiography/surgery
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Weight-Bearing
Young Adult

Figure

• 

  Fig. 1 (A) Acetabular weight-bearing area was divided into three 30° ranges on the midsagittal view according to Nishii et al.12) (B) Drawing of the weight-bearing area with 15° intervals at the center of the femoral head. (C) Comminuted fracture in the weight-bearing area.

• 

  Fig. 2 (A) A transverse skin incision 2 cm above the pubic symphysis. (B) Elevation of abdominal fascia over the rectus abdominis. (C) Midline split of the rectus abdominis. (D) Identification of the obturator nerve. (E) Elevation of rectus insertion on the pubis and ligation of corona mortis. (F) Subperiosteal dissection and open reduction and internal fixation.

• 

  Fig. 3 Preoperative (A) and postoperative (B) radiographs demonstrating placement of a double plate; one over the pelvic brim and the other over the quadrilateral plate. Preoperative (C) and postoperative (D) radiographs demonstrating fixation of a high anterior column fracture with a plate through the lateral window and another fixation over the entire pelvic brim from the pubic body to the anterior aspect of the sacroiliac joint.

Reference

1. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res. 1993; (292):62–76.

2. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996; 78(11):1632–1645.

3. Min BU, Nam SY, Kang CS. Complications of surgical treatment in patients with acetabular fractures. J Korean Hip Soc. 2000; 12(3):253–260.

4. Judet R, Judet J, Letournel E. Surgical treatment of recent fractures of the acetabulum: apropos of 46 operated cases. Mem Acad Chir (Paris). 1962; 88:369–377.

5. Letournel E, Judet R. Fractures of the acetabulum. Berlin: Springer-Verlag;1974.

6. Andersen RC, O'Toole RV, Nascone JW, Sciadini MF, Frisch HM, Turen CW. Modified stoppa approach for acetabular fractures with anterior and posterior column displacement: quantification of radiographic reduction and analysis of interobserver variability. J Orthop Trauma. 2010; 24(5):271–278.

7. Stoppa RE, Rives JL, Warlaumont CR, Palot JP, Verhaeghe PJ, Delattre JF. The use of Dacron in the repair of hernias of the groin. Surg Clin North Am. 1984; 64(2):269–285.

8. Rives J, Stoppa R, Fortesa L, Nicaise H. Dacron patches and their place in surgery of groin hernia: 65 cases collected from a complete series of 274 hernia operations. Ann Chir. 1968; 22(3):159–171.

9. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach: description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994; (305):112–123.

10. Hirvensalo E, Lindahl J, Bostman O. A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res. 1993; (297):28–32.

11. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction: preliminary report. J Bone Joint Surg Am. 1964; 46(8):1615–1646.

12. Nishii T, Tanaka H, Nakanishi K, Sugano N, Miki H, Yoshikawa H. Fat-suppressed 3D spoiled gradient-echo MRI and MDCT arthrography of articular cartilage in patients with hip dysplasia. AJR Am J Roentgenol. 2005; 185(2):379–385.

13. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. Clin Orthop Relat Res. 1994; (305):10–19.

14. Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum: a retrospective analysis. Clin Orthop Relat Res. 1986; (205):230–240.

15. Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum: early results of a prospective study. Clin Orthop Relat Res. 1986; (205):241–250.

16. Letournel E, Judet R, Elson RA. Late complication of operative treatment within three weeks of injury. In : Letournel E, Judet R, Elson RA, editors. Fractures of the acetabulum. 2nd ed. Berlin: Springer-Verlag;1993. p. 541–563.

17. Borrelli J Jr, Goldfarb C, Ricci W, Wagner JM, Engsberg JR. Functional outcome after isolated acetabular fractures. J Orthop Trauma. 2002; 16(2):73–81.

18. Vrahas MS, Widding KK, Thomas KA. The effects of simulated transverse, anterior column, and posterior column fractures of the acetabulum on the stability of the hip joint. J Bone Joint Surg Am. 1999; 81(7):966–974.

19. Hirvensalo E, Lindahl J, Kiljunen V. Modified and new approaches for pelvic and acetabular surgery. Injury. 2007; 38(4):431–441.

20. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969; 51(4):737–755.

21. Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res. 1988; (230):83–97.

22. Pantazopoulos T, Mousafiris C. Surgical treatment of central acetabular fractures. Clin Orthop Relat Res. 1989; (246):57–64.

23. Marsh JL, Buckwalter J, Gelberman R, et al. Articular fractures: does an anatomic reduction really change the result. J Bone Joint Surg Am. 2002; 84(7):1259–1271.

24. Letournel E, Judet R. Fractures of the acetabulum. 2nd ed. Berlin: Springer-Verlag;1993.

25. Pennal GF, Davidson J, Garside H, Plewes J. Results of treatment of acetabular fractures. Clin Orthop Relat Res. 1980; (151):115–123.

26. Letournel E, Judet R, Elson RA. General principles of management of acetabular fractures. In : Letournel E, Judet R, Elson RA, editors. Fractures of the acetabulum. 2nd ed. Berlin: Springer-Verlag;1993. p. 347–361.